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      Efectos de la rehabilitación pulmonar sobre calidad de vida y tolerancia al esfuerzo Translated title: Effects of pulmonary rehabilitation on quality of life and exercise tolerance

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          Abstract

          Resumen Introducción: La rehabilitación pulmonar es una intervención que disminuye los síntomas de la Enfermedad Pulmonar Obstructiva Crónica (EPOC), incrementa la tolerancia al ejercicio, el estado emocional, la funcionalidad, la participación y la percepción de control de la enfermedad, mejorando la calidad de vida. Objetivo: Describir los efectos de la RP sobre dos escalas de calidad de vida y su influencia en la capacidad aeróbica funcional en pacientes con EPOC. Materiales y métodos: Estudio cuasiexperimental en pacientes que asistieron a rehabilitación pulmonar. La capacidad aeróbica funcional se evaluó con el test de caminata de 6 minutos y la calidad de vida relacionada con la salud con los cuestionarios St. George Respiratory Questionnaire (SGRQ) y Chronic Respiratory Disease Questionnaire (CRQ-SAS). Resultados: Se encontró un aumento significativo en el test de caminata de 6 minutos (p<0.001). En el SGRQ se registraron mejorías en categorías de actividad, síntomas, impacto y puntuación total (p≤ 0,005). En el CRQ-SAS se registró mejoría en los dominios disnea, emocional y puntuación total (p<0,001). Conclusiones: La rehabilitación pulmonar favorece la calidad de vida evaluada con el SGRQ y el CRQ-SAS y la capacidad aeróbica funcional de los pacientes con EPOC.

          Translated abstract

          Abstract Introduction: Pulmonary rehabilitation is an intervention that decreases the symptoms of chronic obstructive pulmonary disease (COPD). PR also improves exercise tolerance, emotional state, and functionality. Pulmonary rehabilitation leads to participation and perception of control of the disease, which ultimately enhances the quality of life. Objective: To describe the effects of PR on quality of life and its influence on the functional aerobic capacity in patients with COPD. Materials and methods: A quasi-experimental study was conducted with patients who attended PR. Functional aerobic capacity was assessed by a 6-minute walking test. The St. George Respiratory (SGRQ) and the Chronic Respiratory Disease (CRQ-SAS) Questionnaires were used to assess health-related quality of life. Results: There was a significant improvement in the 6-minute walking test. Based on the SGRQ, the categories of activity, symptoms, impact, and the total score revealed significant improvements (p≤ 0,005). Finally, the CRQ-SAS registered a positive effect of PR on the domains dyspnea, emotional and total score (p<0,001). Conclusions: PR improves quality of life and functional aerobic capacity of COPD patients.

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          Interpreting small differences in functional status: the Six Minute Walk test in chronic lung disease patients.

          Functional status measurements are often difficult to interpret because small differences may be statistically significant but not clinically significant. How much does the Six Minute Walk test (6MW) need to differ to signify a noticeable difference in walking ability for patients with chronic obstructive pulmonary disease (COPD)? We studied individuals with stable COPD (n = 112, mean age = 67 yr, mean FEV1 = 975 ml) and estimated the smallest difference in 6MW distances that was associated with a noticeable difference in patients' subjective comparison ratings of their walking ability. We found that the 6MW was significantly correlated with patients' ratings of their walking ability relative to other patients (r = 0.59, 95% confidence interval [CI]: 0.54 to 0.63). Distances needed to differ by 54 m for the average patient to stop rating themselves as "about the same" and start rating themselves as either "a little bit better" or "a little bit worse" (95% CI: 37 to 71 m). We suggest that differences in functional status can be statistically significant but below the threshold at which patients notice a difference in themselves relative to others; an awareness of the smallest difference in walking distance that is noticeable to patients may help clinicians interpret the effectiveness of symptomatic treatments for COPD.
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            Interpretation of treatment changes in 6-minute walk distance in patients with COPD.

            There is uncertainty about the interpretation of changes in the 6-min walk distance (6MWD) in chronic obstructive pulmonary disease (COPD) patients and whether the minimal important difference (MID) for this useful outcome measure exists. Data were used from nine trials enrolling a wide spectrum of COPD patients with 6MWD at baseline and follow-up and used to determine threshold values for important changes in 6MWD using three distribution-based methods. Anchor-based methods to determine a MID were also evaluated. Data were included of 460 COPD patients with a mean+/-sd forced expiratory volume in one second (FEV(1)) of 39.2+/-14.1% predicted and 6MWD of 361+/-112 m at baseline. Threshold values for important effects in 6MWD were between 29 and 42 m, respectively, using the empirical rule effect size and the standardised response mean. The threshold value was 35 m (95% confidence interval 30-42 m) based on the standard error of measurement. Correlations of 6MWD with patient-reported anchors were too low to provide meaningful MID estimates. 6-min walk distance should change by approximately 35 m for patients with moderate to severe chronic obstructive pulmonary disease in order to represent an important effect. This corresponds to a 10% change of baseline 6-min walk distance. The low correlations of 6-min walk distance with patient-reported anchors question whether a minimal important difference exists for the 6-min walk distance.
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              Lower mortality after early supervised pulmonary rehabilitation following COPD-exacerbations: a systematic review and meta-analysis

              Background Pulmonary rehabilitation (PR), delivered as a supervised multidisciplinary program including exercise training, is one of the cornerstones in the chronic obstructive pulmonary disease (COPD) management. We performed a systematic review and meta-analysis to assess the effect on mortality of a supervised early PR program, initiated during or within 4 weeks after hospitalization with an acute exacerbation of COPD compared with usual post-exacerbation care or no PR program. Secondary outcomes were days in hospital, COPD related readmissions, health-related quality of life (HRQoL), exercise capacity (walking distance), activities of daily living (ADL), fall risk and drop-out rate. Methods We identified randomized trials through a systematic search using MEDLINE, EMBASE and Cocharne Library and other sources through October 2017. Risk of bias was assessed regarding randomization, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting, and other biases using the Cochrane Risk of Bias tool. Results We included 13 randomized trials (801 participants). Our meta-analyses showed a clinically relevant reduction in mortality after early PR (4 trials, 319 patients; RR = 0.58 (95% CI: [0.35 to 0.98])) and at the longest follow-up (3 trials, 127 patients; RR = 0.55 (95% CI: [0.12 to 2.57])). Early PR reduced number of days in hospital by 4.27 days (1 trial, 180 patients; 95% CI: [− 6.85 to − 1.69]) and hospital readmissions (6 trials, 319 patients; RR = 0.47 (95% CI: [0.29 to 0.75])). Moreover, early PR improved HRQoL and walking distance, and did not affect drop-out rate. Several of the trials had unclear risk of bias in regard to the randomization and blinding, for some outcome there was also a lack of power. Conclusion Moderate quality of evidence showed reductions in mortality, number of days in hospital and number of readmissions after early PR in patients hospitalized with a COPD exacerbation. Long-term effects on mortality were not statistically significant, but improvements in HRQoL and exercise capacity appeared to be maintained for at least 12 months. Therefore, we recommend early supervised PR to patients with COPD-related exacerbations. PR should be initiated during hospital admission or within 4 weeks after hospital discharge. Electronic supplementary material The online version of this article (10.1186/s12890-018-0718-1) contains supplementary material, which is available to authorized users.
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                Author and article information

                Journal
                reus
                Universidad y Salud
                Univ. Salud
                Universidad de Nariño (Pasto, Nariño, Colombia )
                0124-7107
                2389-7066
                August 2020
                : 22
                : 2
                : 157-165
                Affiliations
                [2] Cali Valle del Cauca orgnameUniversidad del Valle orgdiv1Facultad de Salud Colombia
                [3] Cali Valle del Cauca orgnameUniversidad Santiago de Cali orgdiv1Facultad de Salud Colombia
                [4] Cali Valle del Cauca orgnameEscuela Nacional del Deporte orgdiv1Grupo Interdisciplinario de Estudios en Salud y Sociedad Colombia
                [1] Cali Valle del Cauca orgnameEscuela Nacional del Deporte orgdiv1Facultad de Salud y Rehabilitación Colombia
                Article
                S0124-71072020000200157 S0124-7107(20)02200200157
                10.22267/rus.202202.187
                04490adb-2a88-4f1a-8cf9-7f234038065d

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 30 April 2020
                : 19 January 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 34, Pages: 9
                Product

                SciELO Colombia

                Categories
                Artículo original

                rehabilitación,Chronic obstructive pulmonary disease,Enfermedad pulmonar obstructiva crónica,quality of life,calidad de vida,exercise,rehabilitation,ejercicio

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